Immigrant and Refugee Health Issues

Demographics

There are four primary categories of immigrants to the United States: legal immigrants, refugees, asylees, and undocumented immigrants. Legal immigrants are individualswhohavebeengrantedpermissionbytheU.S. Bureau of Citizenship and Immigration Services to enter the United States either permanently or temporarily. A refugee is a person who is forced to flee his or her country because of persecution or war and who is granted refugee status prior to entering the United States. An asylee is also someone who is fleeing his or her country because of persecution or war, but an asylee enters the United States without legal permission. Once an asylee is in the United States, he or she must apply for refugee status. If denied, he or she will be deported. Undocumented immigrants do not have permission to be in the United States and can be deported when discovered. In 2006, there were an estimated 35.7 million foreign-born persons in the United States, of whom approximately 10 million were undocumented.

Unlike the early 1900s, when the majority of immigrants came from Europe, the majority of immigrants [Page 526]to the United States since the 1980s were born in Latin America or in Asia. The countries of origin for the majority of immigrants to the United States are listed in Table 1. In 2005, 53,813 persons were admitted to the United States as refugees. The leading countries of origin for refugees were Somalia, Laos, Cuba, and Russia. Immigrant and refugee populations are heavily concentrated in eight states (California, New York, Florida, Texas, New Jersey, Illinois, Minnesota, and Washington), although there has been significant growth in immigrant and refugee populations in nearly all states over the past decade.

Immigrants and refugees are often characterized as poorer and less educated than U.S.-born persons; however, there are significant exceptions to this generalization, including considerable subgroup differences by country of origin. This variation can affect data collection and interpretation, health status, and the potential success of interventions to improve health.

The Healthy Immigrant Effect

The effect of migration on health is controversial. Some studies have shown that first-generation immigrants enjoy superior health and have lower mortality rates compared with U.S.-born persons, despite higher rates of poverty and worse access to health care. This has been dubbed the healthy immigrant effect. As immigrants and refugees adopt traditional American health behaviors over time, their health status begins to converge with that of the general population. The literature on how acculturation influences health status and health behaviors is often difficult to interpret because there are few validated and consistent measures of acculturation. In addition, there is evidence that the effects of acculturation vary, depending on the health behavior or outcome being studied, and among men and women. More recent research has found that some immigrant and refugee groups experience much higher rates of disease and poor health than previously suspected. Understanding how migration affects health is challenging because of gaps in national databases, the heterogeneity of immigrant populations, and difficulty in tracking immigrant populations over time. Data on immigrant health status are also often difficult to interpret because of the uncertain impact of selection biases. For example, immigrants and refugees to the United States may represent the most healthy and motivated individuals—those who are able to make the long journey to the United States, have healthier diets and lifestyles, and engage in fewer risk-taking behaviors. They may also return to their native country prior to dying, and therefore not be counted in U.S. death records or vital statistics.

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